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Aboriginal and Torres Strait Islander Health Performance Framework - Summary report

Leading causes of disease burden and mortality

Burden of disease

In 2018, Aboriginal and Torres Strait Islander (First Nations) people lost 239,942 years due to premature death or living with disease or injury, which equates to around 289 DALY for every 1,000 First Nations people. The rate of disease burden among First Nations people was more than double (2.3 times) that of non-Indigenous Australians in 2018. After adjusting for differences in population size and age structure:

  • 400 years were lost to disease burden for every 1,000 First Nations people
  • 177 years were lost to disease burden for every 1,000 non-Indigenous Australians.

Among First Nations people aged under 75, almost two-thirds (64%) of the fatal burden of disease was due to potentially avoidable deaths (AIHW 2022d).

Between 2003 and 2018, after adjusting for population growth and ageing, the total burden for First Nations people declined by 15%. The decrease was driven by a 27% decline in fatal burden. There was no substantial change in non-fatal burden over the same period.

These results come from Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018 (AIHW 2022d), the latest available burden of disease information for First Nations people and non-Indigenous Australians.

What is the burden of disease and how is it measured?

‘Burden of disease’ refers to the impact of disease and injury on a population. It is measured in ‘disability adjusted life years’ (DALY), which comprises:

  • years lost from dying prematurely (YLL), also known as fatal disease burden
  • years lost due to living with disease or injury (YLD), also known as non-fatal disease burden.

Among First Nations people, 23% of total disease burden in 2018 was due to mental and substance use disorders (54,263 DALY). The other leading causes were:

  • injuries (12% or 29,769)
  • cardiovascular disease (10% or 24,612)
  • cancer (9.9% or 23,742)
  • musculoskeletal conditions (8.0% or 19,168) (Figure 4.5).

First Nations people in Very remote (492 DALY per 1,000 population) and Remote (486 DALY per 1,000 population) areas experienced higher rates of total burden than those living in Major cities (393 DALY per 1,000 population). The mental and substance use disorders disease group was the leading contributor to burden in all remoteness areas, ranging from 17% to 27% of total burden.

First Nations people living in the most socioeconomic disadvantaged areas experienced more than 3 times the total burden of First Nations people in the least socioeconomic disadvantaged areas (591 and 164 DALY per 1,000 population, respectively).

Figure 4.5: Leading causes of disease burden among First Nations people, by sex, 2018

This cumulative bar chart shows that for First Nations males, the leading 4 causes of disease burden were: mental and substance use disorders (23%), injuries (including suicide) (16%), and cardiovascular diseases (11%) and cancer (10%). For First Nations females, the leading 4 causes were: mental and substance use disorders (22%), cancer (10%), musculoskeletal disorders (10%), and cardiovascular disease (9%).

Source: adapted from Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018 (AIHW 2022d).

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Avoidable deaths

Potentially Avoidable deaths

Potentially avoidable deaths are premature deaths – among those aged under 75 – from health conditions and injuries that could potentially be avoided with disease prevention and population health initiatives or access to timely and effective health care.

Avoidable deaths, as a measure, is often used as an indicator of the quality, effectiveness, and accessibility of the health system.

Over the 5-year period 2015–2019, there were 7,366 potentially avoidable deaths among First Nations people, accounting for 60% of all deaths of First Nations people aged 0–74 (data from New South Wales, Queensland, Western Australia, South Australia, and the Northern Territory combined). The rate of potentially avoidable deaths among First Nations people was 208 deaths per 100,000 population, with a higher rate in more remote areas, ranging from 142 deaths per 100,000 population in Major cities to 329 deaths per 100,000 population in Remote and very remote areas.

Between 2010 and 2019, there was no significant change in the rate of potentially avoidable deaths for First Nations people. In comparison, the rate decreased by 13% for non-Indigenous Australians. Over the same decade, there was no significant change in the gap (rate difference) in the rate of potentially avoidable deaths between First Nations people and non-Indigenous Australians (Figure 4.6). The relative difference in rates between First Nations people and non-Indigenous Australians (rate ratio) ranged between 2.8 in 2011 and 3.3 in 2019.

Figure 4.6: Potentially avoidable deaths by Indigenous status (age-standardised rate) (2010–2019), and by remoteness for First Nations people (crude rate) (2015–2019) 

The line chart which shows that the rate of avoidable deaths declined between 2010 and 2019, from 328 per 100,000 to 323 per 100,000 for First Nations people, and from 114 to 98 for non-Indigenous Australians. The column chart shows that for First Nations people, the rate of avoidable deaths increased with increasing remoteness, from 142 per 100,000 in Major cities to 329 per 100,000 in Remote areas.

Note: Data from New South Wales, Queensland, Western Australia, South Australia, and the Northern Territory combined.
Source: Measure 1.24, Table D1.24.2 and Table D1.24.6 – AIHW National Mortality Database.

In 2015–2019, the leading 5 causes of potentially avoidable deaths among First Nations people were:

  • coronary heart disease (21.0%, 1,560 deaths)
  • diabetes (12.0%, 868 deaths)
  • suicide and self-inflicted injuries (11.0%, 843 deaths)
  • chronic obstructive pulmonary disease (8.8%, 651 deaths)
  • cancer (8.0%, 587 deaths).

The age-standardised rates of potentially avoidable deaths due to these five leading causes were consistently higher for First Nations people than for non-Indigenous Australians (Figure 4.7). The conditions contributing most to the gap in rates of potentially avoidable deaths between First Nations people and non-Indigenous Australians were coronary heart disease (26% of the gap in avoidable deaths), diabetes (18% of the gap) and chronic obstructive pulmonary disease (13% of the gap).

Figure 4.7: Rate of potentially avoidable deaths, top 5 causes, by Indigenous status, 2015–2019 (age-standardised)

This column chart presents death rates for the five top causes of avoidable deaths for First Nations people, as well as the equivalent avoidable death rate for non-Indigenous Australians. The leading causes of avoidable deaths for First Nations people were coronary heart disease, diabetes, COPD, cancer and suicide and self-inflicted injuries. Rates were higher for First Nations people than non-Indigenous Australians for all 5 of these causes.

Notes
1. Data from New South Wales, Queensland, Western Australia, South Australia, and the Northern Territory combined.
2. Data are shown for the top 5 causes of avoidable death for First Nations people.
Source: Measure 1.24, Table D1.24.5 – AIHW and ABS analysis of National Hospital Mortality Database.

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Mortality rates and leading causes of death

In the 5-year period 2015–2019, there were 15,439 deaths of First Nations people, corresponding to 430 deaths per 100,000 population. Between 2010 and 2019, there was no significant reduction in the age-standardised death rate among First Nations people.

In 2015–2019, cancer and other neoplasms was the leading broad cause of death among First Nations people, accounting for 23% (3,612 deaths) of all deaths in this period. Cancer (as a broad disease group) was closely followed by cardiovascular disease (23.0%, 3,471 deaths), injury and poisoning (15.0%, 2,240 deaths), respiratory disease (9.7%, 1,498 deaths), and endocrine, nutritional and metabolic diseases (8.6%, 1,333 deaths) as the leading broad causes of death for First Nations people.

Death rates for First Nations males were higher than for First Nations females across most leading causes (except for kidney diseases (6.5 compared with 9.1 deaths per 100,000 population) and diabetes (29 compared with 34 deaths per 100,000)), where rates were higher for First Nations females. Death rates from all the leading causes of death were higher for First Nations people in remote areas than in non-remote areas.

The age-standardised death rate due to endocrine, nutritional and metabolic diseases for First Nations people was 3.7 times as high as for non-Indigenous Australians (86 compared with 23 deaths per 100,000 population).

For deaths caused by both injury and poisoning, and respiratory disease, death rates were twice as high for First Nations people compared with non-Indigenous Australians (79 compared with 40 deaths per 100,000 population; and 106 compared with 52 deaths per 100,000 population, respectively).

For chronic obstructive pulmonary disease, the age-standardised death rate for First Nations people was almost 3 times as high as for non-Indigenous Australians (69 compared with 25 deaths per 100,000 population).

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Perinatal, infant, and child mortality

Content warning: This content contains information some readers may find distressing. If this information raises any issues for you, contact Red Nose Grief and Loss on 1300 308 307 or 13YARN on 13 92 76. Go to the support services page for a list of support services.

Perinatal deaths include stillbirths (deaths prior to or during labour and/or birth) and neonatal deaths (within 28 days following birth).

Over the decade from 2011 to 2020, there was no significant change in the rate of perinatal deaths for babies born to First Nations mothers. There was no significant change in the rate of stillbirths (varying between 8.3 deaths and 13.3 deaths) or neonatal deaths (varying between 3.7 and 6.5 deaths per 1,000 live births) (Figure 4.8). There was also no statistically significant change in the perinatal death rate for babies born to non-Indigenous mothers, nor in the gap between the rates for First Nations and non-Indigenous mothers.

In New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined, the death rates of First Nations infants (aged under 1) did not change significantly from 2012 to 2021, which varied between 4.3 and 6.8 deaths per 1,000 livebirths. The death rate among First Nations children (aged 0–4) did not change significantly, ranging between 127 and 164 deaths per 100,000 children (Figure 4.8).

Figure 4.8: Rate of perinatal (2011–2020) and child deaths (2012–2021), by Indigenous status

The first line chart shows that for First Nations people, the rate of perinatal deaths was highest in 2011 (19 per 1,000 live births) and generally decreased to a low in 2015 (12 per 1,000) before increasing in the years up to 2020 (17 per 1,000). The perinatal death rate among non-Indigenous Australians remained constant (around 9.8 deaths per 1,000 live births) over this period.The second line shows that, over the period from 2012 to 2021 there was no clear trend in the rate of child deaths among First Nations people, while the rate for non-Indigenous children decreased.

Notes
1. Perinatal death is based on the Indigenous status of the mother.
2. Child deaths data New South Wales, Queensland, Western Australia, South Australia, and the Northern Territory combined. Child deaths include children aged 0–4.
Source: Measure 1.21, Table D1.21.2 – AIHW analysis of the National Perinatal Data collection; and Measure 1.20, Table D1.20.3 – AIHW National Mortality Database.

Note that data pertaining to perinatal deaths are from the AIHW’s National Perinatal Mortality Data Collection (NPMDC). These data points are sourced from midwives and other birth attendants, who collect information from mothers, perinatal administrative and clinical record systems. This differs to the source used for reporting on infant and child deaths (the National Mortality Database), which is based on death registrations. The 2 collections are not directly comparable.

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